HIV and AIDS Knowledge Among the Adolescent

Introduction:

Adolescents enter into their sexual and reproductive years; they encounter an array of health and social vulnerabilities that can compromise both their immediate and long-term health and economic prospects. In fact, attention to adolescent health care in general, and adolescent reproductive health in particular has been notably ignored in Bangladesh, despite the large population profile of this age group. Key factors have been the traditional social stigma concerning adolescent sexuality and competing priorities within the health sector.

Unmarried adolescents are generally considered as asexual beings. Adults are often not sensitive to their reproductive and sexual needs and rights. They, therefore, tend to underestimate problems faced by the adolescents. Disapproval and judgmental attitudes of health care providers discourage adolescents from visiting health care facilities. Consequently, they have limited access to RH information and services, which put them at greater health risks (Barkat et al. 2000; Bhuiya et al. 2004; Haider et al. 1997; Nahar et al. 1999; Rahman et al. 2006). The effects of globalization, rising age at marriage, rapid urbanization, and growing opportunities to socialize have increased their risks although they live in a conservative society. Several studies show that adolescents of Bangladesh are engaged in pre- and extra-marital sex (Bhuiya et al. 2004; Rob and Mutahara 2001). They also suffer from psychosexual and RTI/STI-related conditions (Chowdhury et al. 1997; ICDDR,B, ACPR and Population Council 2006; Rahman et al. 2006). Furthermore, they do not use condoms and do not seek services from qualified service providers. In a recent study, over one-fifth of unmarried males reported having had premarital sex; more than half had never used condoms; and one-fourth reported having had one or more STI-related symptoms (ICDDR,B, ACPR and Population Council 2006). Young, unmarried girls are at risk of sexual violence and experience pre-marital sex. However, their sexual and reproductive health needs are not acknowledged.

Furthermore, a larger proportion of adolescents are engaged in economic activities than before, with a trend toward more young women finding gainful employment in urban and semi-urban areas in industrial sectors such as the garment industry. These trends are accompanied by a significant risk of sexual harassment and sexual abuse. A review by UNICEF Bangladesh indicated that the mean age for sexual abuse was 11.6 years, and most rape cases took place among very young girls, including children. About a quarter of child domestic workers were sexually abused, and most acid survivors were under 18 (MOHFW, 2006). That there is a great need for health sector programming dedicated to adolescent reproductive health has been long acknowledged by international agencies and governments.

 Adolescents lack information on their bodies, sexuality, where to obtain information on contraception, and how to protect themselves from unplanned pregnancy and STIs/HIV/AIDS.  They lack developmental skills on how to protect themselves from unwanted and unsafe sexual encounters.  Although some adolescents have reproductive health problems (unplanned pregnancies, STIs, need for HIV prevention, maternity care or post abortion care), they often do not receive reproductive health services.  The limited reproductive health services that exist are often non-responsive to the broader needs of adolescents.

 Bangladesh is still considered as a low HIV/AIDS prevalent country. However, it is at a critical moment in the course of its AIDS epidemic. It is estimated that there are 13,000 HIV-positive people in the country and that HIV prevalence in the adult population is less than 0.01 percent. However, the country’s vulnerability is very high. National HIV surveillance indicates that the rate of HIV infection among street-based sex workers in central Bangladesh is high compared with sex workers in other parts of South Asia. HIV among injecting drug users is already four percent.

Age segregated data shows that HIV and AIDS are common among the people who are 16 to 45 years. About one-fifth of the HIV and AIDS infected people are within 16 to 25 years of age. Though 77 percent of the HIV infected/positives are married but still a significant percentage of HIV and AIDS positive or infected are unmarried adolescents and youth (13.2 percent).

In recent years, knowledge about HIV and AIDS has increased across the country. Most adolescents were aware of HIV/AIDS. Study findings suggest that ninety-three percent of the male and 78 percent of the female adolescents either knew about or had heard of HIV. Similarly, a large number of the adolescents had knowledge on routes of HIV transmission. Most (90 percent) adolescents could correctly mention that the major routes of HIV transmission are: receiving HIV-infected blood transfusion, using non-sterilized syringe, having unsafe sex, and having sex with multiple sexual partners. However, the adolescents had some misconceptions about the routes of HIV transmission. Although the knowledge of transmission is high but still a significant percentage (15 percent) of adolescent did not know how to prevent it. It was also found that the proportion having knowledge on the prevention of HIV/AIDS was almost equal between the male and the female adolescents, except the use of condom during sex (NIPORT, Mitra and Associates, and Macro International 2009; Hena 2009; Rob 2004).

Rational of the study:

As adolescents enter into their sexual and reproductive years, they encounter an array of health and social vulnerabilities that can compromise both their immediate and long-term health and economic prospects. In fact, attention to adolescent health care particularly knowledge of HIV spread and prevention is very important to protect themselves from HIV and non-HIV STIs. The adolescent reproductive health in particularly important for improve the reproductive health of adolescents and to protect from HIV and non-HIV RTIs. Male adolescents usually involved in risky behavior, so it is important to provide information about RH issues. On the other hand female adolescents are more vulnerable because of social insecurity as well as to engage in different risky employment such as in garment factory. Different study shows that about 10 percent adolescent engage in premarital sex without having knowledge of safe sex. To design strategy to provide information, it is essential to know their knowledge as well as their recommendations in the issues.  A cross sectional study will be conducted to assess the baseline knowledge on HIV and non-HIV STIs and their recommendation to improve the knowledge.

Literature review:

Unmarried adolescents are generally considered as asexual beings. Adults are often not sensitive to their reproductive and sexual needs and rights. They, therefore, tend to underestimate problems faced by the adolescents. Disapproval and judgmental attitudes of health care providers discourage adolescents from visiting health care facilities. Consequently, they have limited access to RH information and services, which put them at greater health risks (Barkat et al. 2000; Bhuiya et al. 2004; Haider et al. 1997; Nahar et al. 1999; Rahman et al. 2006).

 The majority of the adolescents had no correct knowledge on human reproduction. Only 40 percent of the male adolescents were aware that once they can ejaculate, they are able to reproduce.  Such knowledge was remarkably low among the female adolescents. Similarly, more than 40 percent of the adolescents reported that onset of menstruation indicates the capability of a female to reproduce, with no difference in opinion between the male and the female adolescents. Only five percent of the adolescents were aware of the fertile period during a menstruation cycle. A considerable number of the male and female adolescents had misconceptions about wet dreams, masturbation, and menstruation. Approximately one-fourth of the adolescents perceived menstruation and wet dreams as diseases. The adolescents also perceived wet dreams and masturbation harmful for health, which was more pronounced among the female adolescents. An important finding was that 26 percent of the urban male adolescents and 17 percent of the rural male adolescents considered masturbation safer than visiting sex workers which indicate the necessity of providing information about safe sex.

Positive perceptions and hygienic management of menstruation are very critical for preventing diseases among female adolescents. Seventy-nine percent of the rural female adolescents dried menstrual clothes under the direct sun compared to 30 percent of the urban female adolescents. On the other hand, 61 percent of the urban and 18 percent of the rural female adolescents dried menstrual cloth inside the room. The majority (72 percent) of the adolescents kept these clothes in hidden, dark and unhygienic places for subsequent use.

It was observed that 85 percent of the male and 62 percent of the female adolescents were aware of family-planning (FP) methods, and most of them knew about contraceptive pills, followed by condom and injections. Only a few adolescents had knowledge of long-term and permanent contraceptive methods. The proportion of the rural adolescents having knowledge on modern contraceptive methods was higher than their urban counterparts. Adolescent facilitators (community-level workers), friends, relatives, and media were the major sources of information for the adolescents. The adolescents mentioned various sources from where they could obtain contraceptive methods, with pharmacies being the dominant source, followed by qualified service providers. Seventy-nine percent of the male and 39 percent of the female adolescents cited pharmacies as the source of FP methods. Other most frequently-mentioned sources for FP services were field workers, upazila, and union-level health facilities.

Knowledge about risks of adolescent pregnancy was almost universal among the adolescents. Over 90 percent were aware of different risks of adolescent pregnancy. About 60 percent reported life-threats to and ill-health of the mother as risks of adolescent pregnancy. Less than 50 percent mentioned life-threats to baby as the health risk of adolescent pregnancy. Although most (97percent) adolescents suggested medical check-up for the pregnant mother, one-third did not know when to go for medical check-up during pregnancy.

Most adolescents were aware of HIV/AIDS. Ninety-three percent of the male and 78 percent of the female adolescents either knew about or had heard of HIV. Similarly, a large number of the adolescents had knowledge on routes of HIV transmission. Most (90 percent) adolescents could correctly mention that the major routes of HIV transmission are: receiving HIV-infected blood transfusion, using non-sterilized syringe, having unsafe sex, and having sex with multiple sexual partners. However, the adolescents had some misconceptions about the routes of HIV transmission. For example, kissing/hugging and mosquito/insect bites were mentioned as routes of HIV transmission by one-fifth of the adolescents.

Fifteen percent of the adolescents did not know how to prevent HIV/AIDS. Two-thirds adolescents mentioned avoiding unscreened blood and non-sterilized syringe as ways to prevent the spread of HIV. The proportion having knowledge on the prevention of HIV/AIDS was almost equal between the male and the female adolescents, except the use of condom during sex. As expected, the urban adolescents had a better knowledge compared to the rural adolescents.

Only 25 percent of the male and five percent of the female adolescents were aware of STIs, except HIV. Half of the male and a little over one-fourth of the female adolescents mentioned avoiding sex with an STI-infected person as a way of preventing STIs. About a similar proportion of the male and female adolescents mentioned use of condom during sex as a preventive measure. The rural male adolescents were more likely to have knowledge about the ways of preventing STIs than their urban counterparts.

 The health hazards of smoking were known to most (97 percent) adolescents, with no marked variation between the male and the female adolescents or between the urban and the rural adolescents. Similarly, knowledge on the health risks of drug-use was common among the adolescents but it varied between the male and the female adolescents. A negligible proportion (9 percent) of the adolescents was smoking but 44 percent of the male and 12 percent of the female adolescents reported that their close friends were as well smoking.

One-fifth of the adolescents visited health facilities for information and services. Of these adolescents, 14 percent were female who came for RH services in stark contrast with less than one percent of the male adolescents. Most adolescents commented positively about various aspects of quality services they received.

The findings of multivariate analyses indicated that the socio-demographic variables and exposure to mass media significantly influenced the knowledge of the adolescents about HIV transmission. The findings further revealed that age, level of education, and affiliation with social organization significantly influenced their knowledge on both HIV transmission and FP but these had no influence on health service-seeking behavior. The effect of exposure to mass media on improved health service-seeking behavior among the adolescents was strong. Therefore, special efforts, such as public awareness on necessity of health services and creation of demand of health services, are needed to improve health service-seeking behavior among adolescents.

Service providers and parents have a significant role to play in improving the knowledge of adolescents about RH. It was observed that the parents themselves had no knowledge on pubertal changes and the fertile period. They perceived wet dream and masturbation harmful for health. Similarly, the service providers did not have adequate skills to provide RH information and services to adolescents. It was found that the service providers did not receive any training on ARH during their job assignment.

Nevertheless, the stakeholders recognized the importance of providing RH information and services to adolescents. The service providers expressed their intention to provide information and services to adolescents. The parents, teachers, and community leaders recommended the establishment of community-based services for adolescents and activities to improve awareness of the RH issues among the community people. The community leaders were also interested to participate in implementing different ARH-related activities and in monitoring community-level activities. The teachers recommended improved sanitary facilities in the school premises for female adolescents. The adolescents requested initiation of activities to sensitize parents regarding parent-child relationships so that children can easily and comfortably share their problems with their parents.

Both government and NGO facilities at the upazila, union and community levels were assessed to determine their readiness to provide services to adolescents. The physical and other facilities of the union-level health centers and community clinics were not in a good condition to provide quality services to adolescents. Most health facilities provided RH services but no HIV counseling was provided at the government facilities. It was observed that there was no ARH-specific behavior change communication (BCC) material at the union-level health facilities while all the NGO facilities had some.

The effects of globalization, rising age at marriage, rapid urbanization, and growing opportunities to socialize have increased their risks although they live in a conservative society. Several studies show that adolescents of Bangladesh are engaged in pre- and extra-marital sex (Bhuiya et al. 2004; Rob and Mutahara 2001). They also suffer from psychosexual and RTI/STI-related conditions (Chowdhury et al. 1997; ICDDR,B, ACPR and Population Council 2006; Rahman et al. 2006). Furthermore, they do not use condoms and do not seek services from qualified service providers. In a recent study, over one-fifth of unmarried males reported having had premarital sex; more than half had never used condoms; and one-fourth reported having had one or more STI-related symptoms (ICDDR,B, ACPR and Population Council 2006). Young, unmarried girls are at risk of sexual violence and experience pre-marital sex. However, their sexual and reproductive health needs are not acknowledged.

Furthermore, a larger proportion of adolescents are engaged in economic activities than before, with a trend toward more young women finding gainful employment in urban and semi-urban areas in industrial sectors such as the garment industry. These trends are accompanied by a significant risk of sexual harassment and sexual abuse. A review by UNICEF Bangladesh indicated that the mean age for sexual abuse was 11.6 years, and most rape cases took place among very young girls, including children. About a quarter of child domestic workers were sexually abused, and most acid survivors were under 18 (MOHFW, 2006). That there is a great need for health sector programming dedicated to adolescent reproductive health has been long acknowledged by international agencies and governments.

Adolescents lack information on their bodies, sexuality, where to obtain information on contraception, and how to protect themselves from unplanned pregnancy and STIs/HIV/AIDS.  They lack developmental skills on how to protect themselves from unwanted and unsafe sexual encounters.  Although some adolescents have reproductive health problems (unplanned pregnancies, STIs, need for HIV prevention, maternity care or post abortion care), they often do not receive reproductive health services.  The limited reproductive health services that exist are often non-responsive to the broader needs of adolescents.

Bangladesh is still considered as a low HIV/AIDS prevalent country. However, it is at a critical moment in the course of its AIDS epidemic. It is estimated that there are 13,000 HIV-positive people in the country and that HIV prevalence in the adult population is less than 0.01 percent. However, the country’s vulnerability is very high. National HIV surveillance indicates that the rate of HIV infection among street-based sex workers in central Bangladesh is high compared with sex workers in other parts of South Asia. HIV among injecting drug users is already four percent.Age segregated data shows that HIV and AIDS are common among the people who are 16 to 45 years. About one-fifth of the HIV and AIDS infected people are within 16 to 25 years of age. Though 77 percent of the HIV infected/positives are married but still a significant percentage of HIV and AIDS positive or infected are unmarried adolescents and youth (13.2 percent).

 In recent years, knowledge about HIV and AIDS has increased across the country. Most adolescents were aware of HIV/AIDS. Study findings suggest that ninety-three percent of the male and 78 percent of the female adolescents either knew about or had heard of HIV. Similarly, a large number of the adolescents had knowledge on routes of HIV transmission. Most (90 percent) adolescents could correctly mention that the major routes of HIV transmission are: receiving HIV-infected blood transfusion, using non-sterilized syringe, having unsafe sex, and having sex with multiple sexual partners. However, the adolescents had some misconceptions about the routes of HIV transmission. Although the knowledge of transmission is high but still a significant percentage (15 percent) of adolescent did not know how to prevent it. It was also found that the proportion having knowledge on the prevention of HIV/AIDS was almost equal between the male and the female adolescents, except the use of condom during sex (NIPORT, Mitra and Associates, and Macro International 2009; Hena 2009; Rob 2004).

 The risk of contacting STIs including HIV/AIDS is a major public health concern for adolescents. Since the sexual habits of unmarried girls and boys of this age group are changing rapidly, knowledge of STIs is crucial. A comprehensive study conducted among adolescents reported that only 13 to 14 percent of them were aware of syphilis and gonorrhea. About one-half of the adolescents could not correctly identify a single STI symptom and more than one-half of the adolescents could not correctly identify a mode of STI transmission.44 Although social customs usually discourage premarital or extra-marital sexual relationships, the scant evidence from small-scale, in-depth qualitative studies indicate that such relationships are more frequent than commonly believed. These groups are especially vulnerable to unwanted pregnancy and disease, including STIs and HIV infection, and the stigma and discrimination associated with either condition.

 Research question:

What is the current situation of the knowledge of HIV and non-HIV STIs among adolescents of secondary school in Bangladesh?

 General objective:

To assess the knowledge of HIV and non-HIV STIs among adolescents of secondary school in Bangladesh.

 Specific objectives:

1. To explore the knowledge on signs and symptoms of RTIs, STIs and HIV/AIDS and the ways of transmission and prevention
2. To identify the indigenous knowledge and practices for RH need
3. To examine the relation between socio-demographic indicators and knowledge of STIs and HIV
4. To identify the recommendation to improve RH of adolescents.

 Materials and methods:

 Study type:

A cross sectional descriptive study will be conducted in  Dhaka town.

 Sampling technique:

Purposively 200 adolescents will be recruited from secondary school in Dhaka district town. Among them 100 adolescent will be boys and 100 girls who are 15-16 years and study in class IX to X. School teacher will confirm the name of respondents.

 Study population:

The study populations will the adolescent boys and girls who study in class VIII to X in secondary school in Dhaka.

 Inclusion criteria:

• Adolescent boys and girls studying in class VIII-X
• Living in  Dhaka.

Exclusion criteria

• Unwilling to participate in the study

Data Collection, Management & Analysis:

Data will be collected through a structured questionnaire and checklist. Baseline information on socio-demographics, knowledge, attitude and practice with respect to HIV and AIDS will be collected from the study participants through interviewer administered questionnaire through face to face interview. Questions will be asked about the danger signs and symptoms of HIV and ways of spread and prevention. It will ask also about non-HIV STIs.

Data analysis will be carried out using SPSS (version 14). Categorical variables were reported as proportion, while continuous variables were reported as means and standard deviations when distributions are considered approximately normal.

Ethical consideration:

Prior to the commencement of this study, the research protocol will be approved by the research committee (Local Ethical committee). The aims and objectives of the study along with its procedure, risks and benefits of this study will be explained to the respondents in easily understandable local language and then informed consent will be taken from each participant. Then it was assured that all information and records will be kept confidential and the procedure will be used only for research purpose and the findings will be helpful for developing awareness package to increase awareness and improve RH knowledge among the adolescent in Bangladesh.

Informed Consent:

A well and clearly understood inform consent form will be filled in up by the respondents and interviewer. However, translations might be carried out after the according to the need of the respondents. This ensures that each of participants will get the information they need to make an informed decision.

Variables:

Independent variables:

Knowledge level of adolescents on HIV/AIDS

 Dependent variables

• Age
• Residence
• Father’s occupation
• Father’s education
• Mother’s education
• Knowledge of signs and symptoms of AIDS
• Ways of spread
• Ways of prevention
• Name of other non-HIV STIs
• Ways of spread of non-HIV STIs
• Know the sources of services for HIV and non HIV STIs

 Operational definition:

1. RTIs: Reproductive tract infection (RTIs) are infections that affect the reproductive tract, which is part of the Reproductive System. For females, reproductive tract infections can be in either the upper reproductive tract (fallopian tubes, ovary and uterus), and the lower reproductive tract (vagina, cervix and vulva); for males these infections are at the penis, testicles, urethra or the sperm tube. The three types of reproductive tract infections are endogenous infections, iatrogenic infections and the more commonly known sexually transmitted infections. Each has its own specific causes and symptoms, caused by a bacterium, virus, fungus or other organism. Some infections are easily treatable and can be cured, some are more difficult, and some are non curable
2. STIs: A sexually transmitted disease (STD), also known as sexually transmitted infection (STI) or venereal disease (VD), is an illness that has a significant probability of transmission between humans or animals by means of sexual contact, including vaginal intercourse, oral sex, and anal sex. While in the past, these illnesses have mostly been referred to as STDs or VD, in recent years the term sexually transmitted infection (STI) has been preferred, as it has a broader range of meaning; a person may be infected, and may potentially infect others, without showing signs of disease. Some STIs can also be transmitted via use of an IV drug needle after its use by an infected person, as well as through childbirth or breastfeeding. Sexually transmitted infections have been well known for hundreds of years.
3. HIV: Human immunodeficiency virus (HIV) is a lentivirus (a member of the retrovirus family) that causes acquired immunodeficiency syndrome (AIDS), a condition in humans in which the immune system begins to fail, leading to life-threatening opportunistic infections. Infection with HIV occurs by the transfer of blood, semen, vaginal fluid, pre-ejaculate, or breast milk. Within these bodily fluids, HIV is present as both free virus particles and virus within infected immune cells. The four major routes of transmission are unsafe sex, contaminated needles, breast milk, and transmission from an infected mother to her baby at birth (Vertical transmission). Screening of blood products for HIV has largely eliminated transmission through blood transfusions or infected blood products in the developed world.
4. AIDS: Acquired immune deficiency syndrome or acquired immunodeficiency syndrome (AIDS) is a disease of the human immune system caused by the human immunodeficiency virus. This condition progressively reduces the effectiveness of the immune system and leaves individuals susceptible to opportunistic infections and tumors. HIV is transmitted through direct contact of a mucous membrane or the bloodstream with a bodily fluid containing HIV, such as blood, semen, vaginal fluid, preseminal fluid, and breast milk. This transmission can involve anal, vaginal or oral sex, blood transfusion, contaminated hypodermic needles, exchange between mother and baby during pregnancy, childbirth, breastfeeding or other exposure to one of the above bodily fluids.

Results

Table 1: Age, education and occupation of the respondents

The study findings show that most of the respondents are from teen age group (98%) that is all of them are adolescents. The study was conducted among the adolescents so the findings proved that the study selected the appropriate respondents and was conducted as well.Most of the respondents are from class ten (58%) which indicate that the study has been collected the right answers from the respondents because this age groups are quite intelligent to understand and responds.

Table 2 Percent distribution of the respondents by listening radio, watch TV

 The study findings show that among the adolescents 31% listen radio everyday and frequently listen radio is 34% that is in total (31%+34%=) 65% adolescents listen radio. Radio is one of the important mass media to aware the people in any topics related to public interests. Adolescent health related information should be an important topic to aware the adolescents as well as the whole community people through this media.

All the adolescents watch television out of them 47% watch it everyday and 53% frequently. The television is also a strong audiovisual media to disseminate public information to aware the people. Adolescent health is an important issue for the nation because 23% o the total population is adolescents and they are the builder of the future nation. So, the issue could be given due attention to disseminate the information on adolescent health.

Table 3 Percent distribution of the respondents by read newspaper

The newspaper is a strong mass print media to which the public have the access. Most of the adolescents read newspaper among them 39% read newspaper everyday and 51% frequently. So, total 90% of the adolescents read newspaper anyway. The finding is a good one because it is the indicator of a good nation. The policy makers should give emphasis on the issue that the adolescent can continue this behavior of reading newspaper to learn various issues through this media.

Table 4: Distribution of the respondents by using drugs and knowledge on possible risk of taking drug.

The study has got a good finding that no adolescents are habituated in taking any drug and they are well aware about the possible harmful effect of drug. Because they expressed that the drug use causing respiratory problems, decrease bodyweight and may cause death if not it is under control.

Table 5: Distribution of the respondents by discuss their personal health matters

 Most of the adolescents share their personal health related matter with their mothers, 63% of the respondents expressed that. The sisters and friends are nearly equal in this regards. The health related matters share with sisters is 19% and with the friends is 18%. The finding indicates that the mothers should have proper knowledge to guide their adolescents including sisters. Because a considerable portion of adolescents share their health problems with their friends, so, the parents should be careful about the friends to whom their children are passing time.

 Table 6: Distribution of the respondents by hard about FP methods and knowledge on preventing STD/AIDS

 All the adolescents are well aware about the family planning methods because 100% of them heard about this method. Among the adolescents 86% of them know that the FP methods prevent STD/AIDS and 5% partially agreed with the comment. Probably both of the groups are right because FP methods prevent STD/AIDS but all the methods are not do it. Only 9% adolescents do not know about it because they are minor and yet to know about the matter.

 Table 7: Distribution of the respondents by knowledge about menstruation, ejaculation and masturbatio

 The study was conducted both fame and female adolescents and naturally one sex could have bit less knowledge about opposite sex. The study finding should that 86% of the adolescents have the idea about menstruation, 68% have the idea about ejaculation and 62% have the idea about masturbation. Considering the age, composition and exposure of the adolescents the findings could be a enthusiastic one because the future generation are growing up by acquiring good knowledge.

Table 8: Distribution of the respondents by their perception of reproductive health knowledge

The finding of the study about the perception of adolescents about reproductive health is quite good. Most of the adolescents perceive menstruation is not a disease but normal physiological phenomenon though 13% perceive it as a disease. Regarding ejaculation, 32% respondents do not know and 19% believe that it is a disease. The perception of the adolescents in this regards is need to be increased by taking interventions. Masturbation is harmful for health it is believe by 62% of the adolescents and 38% adolescents do not know about it. Here also demand interventions to increase the knowledge of the adolescents.

 Table 9: Distribution of the respondents by  their knowledge about HIV/AIDS

Most of the respondents have heard about HIV/AIDS (90%) because of their exposure in different medias. Only 8% of the adolescents do not have any idea about how the HIV/AIDS is transmitted and all other 90% have the idea about different ways of transmission of the disease, 34% expressed that by using condom the disease can be prevented, 30% adolescents opined that avoid un-screened blood transfusion could prevent it and 28% believe that non-sterile syringe avoiding is the remedy to prevent the disease. All the idea and knowledge about the disease is correct.

 Total 48% of the adolescents have the idea that a healthy looking person has the AIDS disease but 34% adolescents do not agree with it. The adolescent knowledge should have increase in this regard.

  Table 10: Distribution of the respondents by transmission of HIV/AIDS

The respondents have the considerable knowledge about the transmission of HIV/AIDS and they know how one can reduce AIDS 89% of them know the answer. AIDS can spared through mosquito bites is not true believe 90% of the adolescents. It should be a critical knowledge on HIV/AIDS. AIDS can be reduced by using condom during sex this statement believe 88% of the adolescents. AIDS can spread through needle sharing is believe by 94% of the adolescents. AIDS can spread through unsafe blood transfusion this statement supports 89% of the adolescents. AIDS can reduced through abstinence of sex, 89% adolescents support this statement.

Table 11: Distribution of the respondents by relation of sex and HIV/AIDS

 The respondents believe that if the relative have the AIDH than the chance of getting infection to the surrounding people is more because of accidental transmission through cut wound. Total 67% of the adolescents believe this idea. Among the adolescents, 90% do agree that the principal way of HIV transmission is sexuality when it is unsafe.

Table 12: Distribution of the respondents by sign symptoms of STDs

 The study finding show an excellent feature of sings symptoms of STDs that prove a good knowledge level in this regard. Among the adolescents, the name STD is known by 100% of the adolescents and among them, Syphilis known by 72% and Gonorrhea by 28%. They are found knowledgeable about the signs and symptoms of STDs, they expressed that pus discharge from urethra 26%, Genital ulcer 18%, Burning sensation during micturition, Swelling on groin area and Pain/swelling on scrotum/testis.

About the Sign and symptom of women STDs, the respondents said that Lower abdominal pain 33%, Vaginal discharge 21% and Pain during intercourse 21%. This is a appreciative finding in the issue of HIV/AIDS and STD in the perspective of gender among the adolescents.

 Table 13: Distribution of the respondents by consequences of HIV/AIDS and STD

The respondents have the considerable knowledge on the treatment of STD patient and said that only the person affected from STD can be treated 69% and the partner and the affected person need treatment said 13% of the respondents.

About the outcome untreated STDs, 79% of the respondents that infertility may develop. The respondents also expressed some other consequences of the untreated STDs.

Table 14: Distribution of the respondents by what to do if one has HIV/AIDS and STD

As the respondents opined about how to get protection from STDs, abstain from sex contribute 11%, use condom during sex 75% among the respondents. If a person suffers from STDs then what should he do, the person should seek treatment from a qualified doctor opined 54% of the respondents, Instructions of doctor should be strictly followed said 29% of the respondents.

Table 15: Distribution of the respondents by source of their information about HIV/AIDS and STDs

 The respondents receive information from various sources about HIV/AIDS like from Upazila health complex 21%, Health and family welfare center 11%, Satellite clinics/EPI outreach 4%, NGO clinic 8%, Book/newspaper/magazine 9%, radio 26% and TV 21%. The TV radio and UH&FPC are the main sources of information round the country though other medias also have some role about disseminating the message.

Table 16: Distribution of the respondents by knowledge about the source of contraceptives and methods of contraception

The respondents said that they know that contraceptive is available in Upazila health complex 18%, Doctors/service provider 21% and Pharmacy 61%. The respondents have heard about the contraceptive from Upazila health complex 31%, Health and family welfare center 34% and from TV 35%. Like HIV/AIDS and STDs here also the mainsources are TV an governmental health facilities.

Discussion:

The study findings show that most of the respondents are from teen age group (98%) that is all of them are adolescents. The study was conducted among the adolescents so the findings proved that the study selected the appropriate respondents and was conducted as well.

 Most of the respondents are from class ten (58%) which indicate that the study has been collected the right answers from the respondents because this age groups are quite intelligent to understand and responds.

 The study findings show that among the adolescents 31% listen radio everyday and frequently listen radio is 34% that is in total (31%+34%=) 65% adolescents listen radio. Radio is one of the important mass media to aware the people in any topics related to public interests. Adolescent health related information should be an important topic to aware the adolescents as well as the whole community people through this media.

 All the adolescents watch television out of them 47% watch it everyday and 53% frequently. The television is also a strong audiovisual media to disseminate public information to aware the people. Adolescent health is an important issue for the nation because 23% o the total population is adolescents and they are the builder of the future nation. So, the issue could be given due attention to disseminate the information on adolescent health.

The newspaper is a strong mass print media to which the public have the access. Most of the adolescents read newspaper among them 39% read newspaper everyday and 51% frequently. So, total 90% of the adolescents read newspaper anyway. The finding is a good one because it is the indicator of a good nation. The policy makers should give emphasis on the issue that the adolescent can continue this behavior of reading newspaper to learn various issues through this media.

The study has got a good finding that no adolescents are habituated in taking any drug and they are well aware about the possible harmful effect of drug. Because they expressed that the drug use causing respiratory problems, decrease bodyweight and may cause death if not it is under control.

Most of the adolescents share their personal health related matter with their mothers, 63% of the respondents expressed that. The sisters and friends are nearly equal in this regards. The health related matters share with sisters is 19% and with the friends is 18%. The finding indicates that the mothers should have proper knowledge to guide their adolescents including sisters. Because a considerable portion of adolescents share their health problems with their friends, so, the parents should be careful about the friends to whom their children are passing time.

 All the adolescents are well aware about the family planning methods because 100% of them heard about this method. Among the adolescents 86% of them know that the FP methods prevent STD/AIDS and 5% partially agreed with the comment. Probably both of the groups are right because FP methods prevent STD/AIDS but all the methods are not do it. Only 9% adolescents do not know about it because they are minor and yet to know about the matter.

The study was conducted both fame and female adolescents and naturally one sex could have bit less knowledge about opposite sex. The study finding should that 86% of the adolescents have the idea about menstruation, 68% have the idea about ejaculation and 62% have the idea about masturbation. Considering the age, composition and exposure of the adolescents the findings could be a enthusiastic one because the future generation are growing up by acquiring good knowledge.

The finding of the study about the perception of adolescents about reproductive health is quite good. Most of the adolescents perceive menstruation is not a disease but normal physiological phenomenon though 13% perceive it as a disease. Regarding ejaculation, 32% respondents do not know and 19% believe that it is a disease. The perception of the adolescents in this regards is need to be increased by taking interventions. Masturbation is harmful for health it is believe by 62% of the adolescents and 38% adolescents do not know about it. Here also demand interventions to increase the knowledge of the adolescents.

Most of the respondents have heard about HIV/AIDS (90%) because of their exposure in different medias. Only 8% of the adolescents do not have any idea about how the HIV/AIDS is transmitted and all other 90% have the idea about different ways of transmission of the disease, 34% expressed that by using condom the disease can be prevented, 30% adolescents opined that avoid un-screened blood transfusion could prevent it and 28% believe that non-sterile syringe avoiding is the remedy to prevent the disease. All the idea and knowledge about the disease is correct.

Total 48% of the adolescents have the idea that a healthy looking person has the AIDS disease but 34% adolescents do not agree with it. The adolescent knowledge should have increase in this regard.

The respondents have the considerable knowledge about the transmission of HIV/AIDS and they know how one can reduce AIDS 89% of them know the answer. AIDS can spared through mosquito bites is not true believe 90% of the adolescents. It should be a critical knowledge on HIV/AIDS. AIDS can be reduced by using condom during sex this statement believe 88% of the adolescents. AIDS can spread through needle sharing is believe by 94% of the adolescents. AIDS can spread through unsafe blood transfusion this statement supports 89% of the adolescents. AIDS can reduced through abstinence of sex, 89% adolescents support this statement.

The respondents believe that if the relative have the AIDH than the chance of getting infection to the surrounding people is more because of accidental transmission through cut wound. Total 67% of the adolescents believe this idea. Among the adolescents, 90% do agree that the principal way of HIV transmission is sexuality when it is unsafe.

The study finding show an excellent feature of sings symptoms of STDs that prove a good knowledge level in this regard. Among the adolescents, the name STD is known by 100% of the adolescents and among them, Syphilis known by 72% and Gonorrhea by 28%. They are found knowledgeable about the signs and symptoms of STDs, they expressed that pus discharge from urethra 26%, Genital ulcer 18%, Burning sensation during micturition, Swelling on groin area and Pain/swelling on scrotum/testis.

About the Sign and symptom of women STDs, the respondents said that Lower abdominal pain 33%, Vaginal discharge 21% and Pain during intercourse 21%. This is a appreciative finding in the issue of HIV/AIDS and STD in the perspective of gender among the adolescents.

The respondents have the considerable knowledge on the treatment of STD patient and said that only the person affected from STD can be treated 69% and the partner and the affected person need treatment said 13% of the respondents.

About the outcome untreated STDs, 79% of the respondents that infertility may develop. The respondents also expressed some other consequences of the untreated STDs. As the respondents opined about how to get protection from STDs, abstain from sex contribute 11%, use condom during sex 75% among the respondents. If a person suffers from STDs then what should he do, the person should seek treatment from a qualified doctor opined 54% of the respondents, Instructions of doctor should be strictly followed said 29% of the respondents.

The respondents receive information from various sources about HIV/AIDS like from Upazila health complex 21%, Health and family welfare center 11%, Satellite clinics/EPI outreach 4%, NGO clinic 8%, Book/newspaper/magazine 9%, radio 26% and TV 21%. The TV radio and UH&FPC are the main sources of information round the country though other medias also have some role about disseminating the message.

The respondents said that they know that contraceptive is available in Upazila health complex 18%, Doctors/service provider 21% and Pharmacy 61%. The respondents have heard about the contraceptive from Upazila health complex 31%, Health and family welfare center 34% and from TV 35%. Like HIV/AIDS and STDs here also the main sources are TV an governmental health facilities.

 Limitations:

The study was conducted only in a single geographical area so the findings could not be representative for the other parts of the country.

It was the dissertation for the partial fulfillment of MPH degree so the maturity of the process of study could be weak because of the less experience of the researcher.

Time and resources constrain were the fact for the researcher so that big sample, different geographical areas were not involved.

Reproductive health knowledge of the adolescents are reflected here but it was not compared with any other age group so in comparison with other group what would be the position of adolescents knowledge is difficult to identify through this dissertation.

\Recommendations:

The respondent adolescents are found knowledgeable about the signs and symptoms of RTIs, STIs and HIV/AIDS and they are very much aware about the ways of transmission of the disease along with how to prevent the spreading of the disease. To continue this situation the awareness raising campaign need to be continued in different ways.

The research was deigned to identify any indigenous knowledge and practices for RH need among the adolescents but the findings show that the respondents have no idea about any indigenous practices rather they have the correct scientific knowledge on what to be done to live a enjoyable reproductive health life. It is due to the dissemination of respective information through different medias and that campaigns should be continued.

Due to multi dimensional dissemination of RH information throughout the society there is no such difference has been identified between the socio-demographic indicators and knowledge of STIs and HIV. It was probably due to the respondents were from a same geographical location.

By analyzing the findings it should be recommended that most of the adolescents get RH related information from mass medias like Radio, TV, newspaper and governmental health facilities like UHC, UHFWC etc so these mass medias and health facilities should be more informative to keep the adolescents healthy by providing them scientific knowledge on reproductive health.

Conclusions:

If the adolescents keep in dark that is out of getting information on RH they should be suffering from lack information on their bodies, sexuality, where to obtain information on contraception, and how to protect themselves from unplanned pregnancy and STIs/HIV/AIDS etc. They would have in lack developmental skills on how to protect themselves from unwanted and unsafe sexual encounters. Although the adolescents have reproductive health problems (unplanned pregnancies, STIs, need for HIV prevention, maternity care or post abortion care), they often do not receive reproductive health services.

Bangladesh is still considered as a low HIV/AIDS prevalent country. However, it is at a critical moment in the course of its AIDS epidemic. It is estimated that there are 13,000 HIV-positive people in the country and that HIV prevalence in the adult population is less than 0.01 percent. However, the country’s vulnerability is very high. National HIV surveillance indicates that the rate of HIV infection among street-based sex workers in central Bangladesh is high compared with sex workers in other parts of South Asia. The adolescents are the near future leader of our country and maintaining the main stream of country’s health and reproductive system. So, to protect them by providing appropriate knowledge is our national responsibility.

References

Annexure:

Annex A: Informed consent form English

Annex B: Informed consent form Bangla

Annex C: Questionnaire

HIV and AIDS knowledge among the adolescent: a gender perspective in Bangladesh